Interface for patient-provider conversation and auto-generation of note or summary

ABSTRACT

A method for automatically generating a note summarizing a conversation between a patient and a healthcare provider is disclosed. A workstation is provided with a tool for rendering an audio recording of the conversation and a display for displaying a transcript of the audio recording obtained from a speech-to-text engine. The display of the workstation includes first transcript region for display of the transcript and a second note region for simultaneous displaying of elements of a note summarizing the conversation. Words or phrases in the transcript related to medical topics relating to the patient are extracted with the aid of a trained machine learning model. The extracted words or phrases are highlighted in the transcript and displayed in the note region. Links or a mapping between the extracted words or phrases in the note region and the portions of the transcript from which the extracted words or phrases originated are provided whereby the source and accuracy of the extracted words or phrases in the note region can be verified by a user.

PRIORITY

This application claims priority benefits to U.S. provisionalapplication Ser. No. 62/575,732 filed Oct. 23, 2017, the content ofwhich is incorporated by reference herein.

BACKGROUND

This disclosure relates generally to the field of medical documentationand note generation, that is, the process by which a healthcare provider(physician or nurse) makes a record of pertinent medical informationgained as a result of a visit with a patient. Currently, physiciansspend an average of 20 percent of their time (2-3 hours per day)documenting patient visits by creating notes (i.e., text descriptions ofsymptoms, chief complaint, relevant medical history, and other pertinentinformation gained during the visit) in the patient's electronic healthrecord. The notes also facilitate proper billing of the patient or theirinsurance company.

There exists a need in the art for methods and systems improving theefficiency of generating notes of patient visits that takes less time ofphysicians, allowing them to see more patients and spend more time onpatient care. There also exists an unmet need for providing transparencyinto the machine transcription and information extraction processes tobuild trust and credibility into the transcription and note generationprocesses, while also minimizing the impact on the user's attention.This disclosure meets these needs. Additionally, this disclosure can besaid to refer to novel interfaces and interactions on a workstation thatprovide supportive emphasis and rapid understanding of machineintelligence outputs in the context of medical documentation.

SUMMARY

This disclosure relates to an interface (e.g., a display of aworkstation used by a provider) for displaying a transcript of apatient-healthcare provider conversation and automated generation of anote or summary of the conversation using machine learning. Thetranscript and note can be generated in substantial real time during theoffice visit when the conversation is occurring, or later after thevisit is over.

The method includes a step of providing on a workstation a tool forrendering an audio recording of the conversation. The method furtherincludes a step of displaying on a display of the workstation (1) infirst transcript region a transcript of the recording in substantialreal time with the rendering of the audio recording and simultaneously(2) in a second note region a note summarizing the conversation, thenote including automatically extracted words or phrases in thetranscript related to medical topics relating to the patient, theextraction of the words or phrase performed with the aid of a trainedmachine learning model. The medical topics relating to the patient couldbe such things as symptoms and attributes thereof such as onset, tempo,severity, location, etc., medications, complaints, etc. The methodfurther includes a step of providing links or a mapping between theextracted words or phrases in the note and the portions of thetranscript from which the extracted words or phrases originated wherebythe source and accuracy of the extracted words or phrases in the notecan be verified by a user, for example by selecting one of the extractedwords or phrases in the note or by inspection of the note side by sidewith the transcript with the extracted words or phrases highlighted inboth the transcript and the note.

The disclosure also features many different aspects and variations ofthe above method. For example, the speakers are identified, i.e.,patient and physician. At the same time as the written transcript isgenerated, medically relevant words or phrases in the transcript areextracted from the conversation and automatically populated into a notedisplayed on the same screen as the transcript. The extracted words orphrases in the note are linked to the corresponding portions of thetranscript from which they originated. The physician can thus inspectthe transcript and the extraction of relevant words and phrases and theauto-generation of the note to confirm the accuracy of the note. Thewords or phrase can be placed into appropriate categories orclassifications in the note such as under headings for symptoms,medications, etc. The transcript (and note) are editable, with versioncontrol to approve, reject or provide feedback on generated suggestionsfor editing the transcript. Alternative words are suggested for speechin the transcript that does not match vocabulary in the automated speechrecognition, or for muffled and partially audible voice input.

The disclosure also relates to aspects of the auto-generated noteitself, including among other things expansion of the note to prose inkey sections or bullet lists of terms based on the doctor's preference;symptom entities and symptom attributes are grouped by classifiers andplaced into specific buckets in the notes. The note is editable to moveclassifiers and groupings or to add new content. There is a feature fordisplay of confidence level for generated suggestions when certain doubtlevels are present, e.g., when the speech is muffled, the patientmispronounces a word, or does not completely remember the name of themedication they are taking. Additionally, the interface can include adisplay of suggestions during the visit or as reminders to follow-upwith the patient, such as suggested questions to ask or suggestedbilling codes with portions of the transcript displayed which justifythe billing codes. Additionally there is a feature for providing anemailable or SMS-ready list of patient instructions at the end of visit,including features for editing the list of instructions, adding newinstructions from a list of available or suggested instructions, and afeature to note medication changes or additions in a list generated fromthe assessment and plan portion of the doctor's notes.

Additionally, this disclosure further describes a method for generatinga transcript of an audio recording of a patient-healthcare providerconversation. The disclosure is related to methods to increase the trustand credibility in the transcript.

The method uses a workstation which provides for a rendering of an audiorecording of the conversation (e.g., through a speaker on theworkstation) and generating a display of a transcript of the audiorecording using a speech-to-text engine in substantial real time withthe rendering of the audio recording. The generating of the transcriptin substantial real time with the rendering of the audio recordingenables inspection of the transcript and verification of the accuracy ofconversion of speech to text, thereby increasing the confidence that thetranscript is accurate. The workstation includes a tool such as a scrollbar for scrolling through full length of the transcript and renderingthe portion of the audio according to the position of the scrollingthrough the transcript. Thus, the user can navigate through thetranscript and re-play the portion of the audio at particular points inthe transcript to confirm the accuracy of the conversion of speech totext.

Additionally, the method involves highlighting in the transcript wordsor phrases spoken by the patient relating to symptoms, medications orother medically relevant concepts. For example if the patient says “Ifelt feverish this morning” the phrase “felt feverish” or just“feverish” and the phrase “this morning” would be highlighted in thetranscript, as they are relating to symptoms and onset of symptomsexperienced by the patient. This feature calls out to the user'sattention particularly important or significant words or phrases in thetranscript.

Additionally, the method provides a set of transcript supplement toolswhich enable editing of specific portions of the transcript based on thecontent of the corresponding portion of audio recording. In particular,there may be portions of the audio recording where the patient's voicemay be muffled, they may mispronounce a significant word, such as thename of a medication, they only remember the first syllable or the pillcolor of the medication they are taking, etc. The transcriptionsupplement tools enable editing of these portions of the transcript,such as by displaying suggested alternative phrases, displayingcorrected medical terminology, displaying suggestions for incompletewords, etc., and tools for accepting, rejecting or editing thetranscript and the generated suggestions.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an illustration of the flow of data from audio input of apatient-healthcare provider visit into a machine learning system andgenerating an output in the form of a set of data for a note of apatient visit and a transcript. FIG. 1 also illustrates several aspectsof the machine learning system.

FIG. 2 is block diagram of a computing environment in which the featuresof the present disclosure can be practiced.

FIG. 3 is an illustration of a transcript and a note generated insubstantial real time automatically during the rendering of an audiorecording of a patient-healthcare provider conversation.

FIG. 4 is an illustration of the ability to edit groupings ofhighlighted medical events or terms in the note.

FIG. 5 is an illustration of features for editing the transcript withsmart suggestions of words to replace text in the transcript, as well asediting of the note.

FIG. 6 shows an example of a note being generated in substantial realtime in a bulleted list format, and tools at the bottom of the displayto switch the note presentation between a bulleted list and prose style.

FIG. 7 is an illustration of a confidence indicator for a phraseappearing in the note.

FIG. 8 is an illustration of a smart searching tool for searching acrossa transcript and a note.

FIG. 9 is an illustration of a linking or mapping between note segmentsand words in the transcript and corresponding audio portion.

FIG. 10 is an illustration of a patient instructions screen in which allpatient instructions are gathered in one spot, and providing tools formanaging a checklist of patient instructions, including adding orremoving handouts for the patient.

FIG. 11 is an illustration of set of patient instructions along withoptions to change SMS or email preferences for contacting the patient.

FIG. 12 is a display of a suggested problem list that supportsphysicians in their decision making which can be generated insubstantial real time during the rendering of the recording of theconversation with the patient. Potential problems that need addressingbut that have not been brought up by the patient are also flagged.

FIG. 13 is a further list of questions that are presented to thephysician which have not been asked, as well as suggested alternativediagnoses and billing codes.

FIG. 14 is an illustration of a minimized widget (icon) on the maindisplay of the terminal of FIG. 2, which allow for access to thetranscript and recording of the visit but which also allows thephysician to navigate through other patient data.

FIG. 15 is an illustration of a generation of a transcript insubstantial real time with the rendering of the audio recording,allowing the physician to view the transcript for accuracy.

FIG. 16 is another form of the transcript which is generated line byline as the recording of the patient-healthcare provider conversation isplayed on the workstation.

FIG. 17 is an illustration of the bullet form of a note like FIG. 6, butaugmented with a new symptom “rash” and location: right shin when thepatient tells their physician “I also have developed a rash on my rightshin . . . .” immediately after describing their fever symptoms.

FIG. 18 is another example of a portion of a note automaticallygenerated from an audio recording in a bulleted list format.

FIG. 19 is an illustration of automatically generated suggestions forthe term spoken by the patient “Lipodrene”; the physician has theability to accept or reject the suggestions.

FIG. 20 is an illustration of display of transcript suggestions foruncertain phrases.

FIG. 21 is an illustration of a prose-style note with terminologyadapted to professionally preferred terms.

DETAILED DESCRIPTION

Overview

One aspect of the present disclosure relates to automated generation ofa transcript of a patient-healthcare provider conversation and aphysician's note documenting the conversation. The flow of informationand software processing is shown in FIG. 1 by the reference number 100.There is an audio input 102 which is made by a recording device presentin the room where the conversation takes place. The recording devicecould, for example, consist of the microphone function of a physician'sworkstation (210, FIG. 2) and conventional audio recording softwarepresent in the workstation. Alternatively, the recording device couldconsist of a special purpose audio recording unit consisting ofmicrophones and software built into or part of the physician's office.The audio input 102 is provided to a machine learning model 104 (orsystem in the form of a collection of machine learning models) whichgenerates a transcript of the recording and extracts words or phrases inthe transcript which form data 106 for a note. The machine learningmodel 104 is shown in FIG. 1 as composed of discrete models implementedin software and hardware, including a model 108 which separates theaudio input into speech by different speakers, in this case the patientand the healthcare provider. This model 108 can be trained by both thepatient and the healthcare provider providing speech training examples.Once the audio input has been separated by speaker by model 108, theaudio input is provided to a speech to text conversion model 110. Thismodel implements traditional speech to text functionality but the model110 is trained using supervised learning techniques and labeled trainingspeech data to recognize medical-related terminology in speech,including things such as symptoms, medications, human anatomical terms,etc.

A named entity recognition model 112 is further included which processesthe text generated by the speech to text conversion model 110 torecognize medically relevant words or phrases. Named entity recognition(NER) models are well known in the field of machine learning and aredescribed extensively in the scientific literature. The NER model 112needs its owned labelled training data. For this training data we use alarge corpus of medical text books (over 120,000 medical text books)using deep learning word embedding, in conjunction with a large lexiconof existing medical ontologies, e.g., UMLS (unified medical languagesystem) and SNOMED (systemized nomenclature of medicine). Additionally,the NER model 112 can be trained from annotated medical encountertranscripts. A NER model can also be trained from a hybrid of datasources, which may include medical and clinical text books, annotatedtranscripts from doctor-patient conversations, and clinicaldocumentation contained in anonymized electronic health records of amultitude of patients.

The result of the application of the named entity recognition model 112as applied to the text generated by the speech to text conversion model110 is a highlighted transcript of the audio input 102 with relevantwords or phrases highlighted (as recognized by the named entityrecognition model) as well as extraction of such highlighted words ortext as data for note generation and classification of highlighted wordsor phrases into different regions or fields of a note, as indicated at114. The application of these models to an audio file and generation ofa transcript and note will be explained in detail in subsequent sectionsof this document.

FIG. 2 is an illustration of one possible physical configuration of acomputing environment in which the features of this disclosure can beimplemented. A clinic, hospital or medical office 200 is the location ofvisit between a healthcare provider 202 and a patient 204. At thatlocation 200 is a recording device 206 (which may be physicallyconnected to or part of the workstation 210) for capturing and recordingthe speech of both the provider 202 and the patient 204. This recordingis converted to digital form and optionally provided over a computernetwork 208 to a workstation 210 which is used by the provider 202 toview the transcript and the note generated in accordance with thefeatures of this disclosure. In one format, the workstation 210 (whichmay be present at the location, e.g., in the physician's office duringthe visit with the patient) may take the form of a desktop computerwhich includes an interface in the form of a display, a keyboard 214 anda mouse 216, as well as microphone built in to record the conversation.The workstation 210 could also take the form of a tablet computer,laptop, smart phone or other format, which includes a facility to render(play) the audio recording, display the transcript, and display thenote, and include the tools explained below for editing the transcriptand note. The workstation 210 also has access to the patient'selectronic health record (EHR) either by having it stored locally indata store 212 or accessible via a network connection.

In FIG. 2, the audio input is also sent over a network 208 and cloud 209to an entity, such as a service provider, which includes a machinelearning system 218 implementing the machine learning models 104 ofFIG. 1. The entity or service provider implementing the machine learningmodels generates the transcript and note and transmits them over anapplication programming interface to software resident on theworkstation 210 to render the transcript and note in substantial realtime as the audio is being recorded (or later on, when recording isplayed on the workstation). Further details on the design andimplementation of the system of FIG. 2 are not particularly relevant tothe present discussion and are omitted for the sake of brevity and inorder to not obfuscate the salient details of the present disclosure.The illustrations, screen display, or pages shown in the subsequentFigures are rendered on the display of the workstation 210.

In one possible configuration the workstation 210 could function as astand-alone system for generating the transcript and the note, in whichcase the machine learning aspects of FIG. 1 are built into specialpurpose processors and computing apparatus on the workstation. Thisembodiment would be suitable for use in remote areas where internetaccess is not available or unreliable.

Alternatively, the machine learning system 218 of FIG. 2 could beimplemented in a local facility to the office 200, such as in a generalpurpose computer or set of computers on the local area network 208. Or,as shown in FIG. 2, the machine learning system 218 could reside in thecould 209 in which case the system receives the audio signal of thedoctor-patient conversation and generates the transcript and note dataand sends it back to the workstation 210 for display on theworkstation's display.

A. Automated Generation of Notes of Patient-Healthcare ProviderConversations

The readers' attention will now be directed to FIGS. 3-14. We will nowdescribe a method for generating a note summarizing a conversationbetween a patient and a healthcare provider. As will be explained ingreater detail below in conjunction with FIG. 3, in essence we provideon a workstation (210 of FIG. 2) a tool (e.g., icon, tab, link, or otheraction on the interface) for rendering, i.e., playing on speakerassociated with the workstation, an audio recording of the conversationand generating a transcript of the audio recording using aspeech-to-text engine (part of the model 110 of FIG. 1). We then displayon a first region 312 (FIG. 3) of a display of the workstation thetranscript of the recording and simultaneously on a second region 314 ofthe display a note summarizing the conversation. Additionally, themethod includes a step of extracting words or phrases in the transcriptrelated to medical topics relating to the health condition of thepatient (such as symptoms, medications, chief complaint, relevantmedical history, etc.) with the aid of a trained machine learning model(NER model 112 of FIG. 1) and displaying in the second region 314 of theworkstation the extracted words or phrase. For example, if the patientspeaks the words “I felt feverish” the term “feverish” is highlighted inthe transcript region 312 and the term “fever” or “feeling feverish” isshown in the note region 314, e.g., under a symptom heading or as partof a prose sentence such as “The patient complained of feelingfeverish.”

Furthermore, in the method links or mapping is provided between theextracted/highlighted words or phrases in the note region 314 and theportions of the transcript from which the extracted words or phrasesoriginated whereby the source and accuracy of the extracted words orphrases can be verified by a user of the workstation. For example, ifthe user of the workstation clicked on the extracted phrase “feelingfeverish” in the note region 314, the transcript region 312 will showthe portion of the transcript in which the patient said they werefeeling feverish. Similarly, if the user clicked on the highlighted term“feeling feverish” in the transcript region the corresponding noteelement “feeling feverish” or “fever” is shown in the note under asymptom heading, or the sentence “The patient complained of feelingfeverish.” is shown with “feeling feverish” highlighted.

In FIG. 3, there is shown one possible format of the display of thetranscript on the interface of the workstation 210. The page shownincludes a transcript tab 308 which has been selected, as well as a notetab 306, a chart tab 304, and patient instructions tab 302. Thetranscript shown in region 312 is editable, that is the user selecthighlight words or phrases in the transcript based on the rendered audiorecording and edit if they see fit to do so. The speaker icon 310indicates that the audio recording is being played, and in substantialreal time the transcript is generated, line by line. For example, theworkstation plays the sound of the patient speaking “No, no fevers oranything like that” and immediately thereafter the transcript isaugmented with the new line of text: Pt: No, no fevers or anything likethat. The Note region 314 includes a history of present illness, whichis generated from data in the electronic health record and/or fromspeech generated in the visit with the provider. The note includescurrent physical examination data, such as blood pressure as indicatedat 316. The transcript area also includes a listing of currentexamination data, such as pulse and weight. The pulse and weight data(from recent vital signs in the patient's electronic health record) isgenerated in response to the highlighted passage at the top of thetranscript where the doctor states “I'd like to take a look at theswelling.”

It will be appreciated that the note set forth in the note field 314 canbe automatically generated from the transcript and making use of themachine learning models of FIG. 1. Validation of the note is possible bymatching note segments to the transcript and corresponding audio, e.g.,by the linking between highlighted words or phrases in the transcript tothe corresponding words or phrases in the note region, and having theaudio played at that portion of the transcript. Furthermore, the audiorecording tools on the workstation display include pause, rewind, play,fast forward, etc., so that the user can start and stop the recording tolisten to sensitive or important patient information and confirm thatthe transcript, highlighted words or phrases, and insertion of words orphrases into the note are correct.

FIG. 4 shows an example of how the highlighted phrases “leg hurts”, 402,and “feeling feverish” 403 are extracted from the transcript and placedinto a note. Furthermore, attributes of the symptom “feeling feverish”,and specifically, onset, alleviating, and tempo (404) are also extractedfrom the transcript and placed into the note. The area 406 is a fieldfor the user to indicate the chief complaint (CC), and whereasoriginally this field is blank the user is able to click and drag thetext “leg hurts” 402 into the CC field 406 as indicated on the rightside of FIG. 4. Thus, the grouping of text elements in the note iseditable.

FIG. 5 illustrates a further example of editing of a transcript 500 anda note. In FIG. 5, the patient has spoken the phrase “I am. Lipodrene.”(502) in response to a question about medication they are taking. Thephrase “Lipodrene” is not recognized as a name of a medication and theNER model of FIG. 1 generates two smart suggestions: Amlodipine andLipozene (504 and 506) which are placed adjacent to the suspect term“Lipodrene.” The user can accept either of these suggestions by clickingon them, or reject them by activating the X icon 508. In the note region314 there is a note 512 being generated automatically as the transcriptis created. The user has typed in the term .EXA (510) to search for anexamination entry into the note and suggested completions of the .EXAsearch are shown based on the search query. The note is editable to moveclassifiers and groupings or to add new content. When entering newcontent, the doctor can use the equivalent quick keys (“smart phrases”or “dot phrases”) of the facility's Electronic Health Record system,such as shown in this example with the .EXA search.

FIG. 6 shows a note being generated automatically as the transcript of aconversation is generated, in which the note 600 is in the form abulleted list. In this particular example, there is a bullet item“Symptoms” and under this heading there is the phrase “feeling . . .feverish” 602 (a quotation from the transcript) along with additionalattributes of the symptom, namely onset and tempo. The note 600 furtherincludes vital signs 604. There are icons at the bottom of the note totrigger additional forms for the display of the note, namely icon 610which triggers display of the transcript side by side with the note,icon 606 which triggers the display of the bulleted list as shown inFIG. 6, and icon 608 which triggers display of the note in a prosestyle.

FIG. 7 shows an example of a display of a confidence indicator 704 whichis generated when there is uncertainty in either the speech that wasrecorded or in suggestions that are generated by the machine learningmodels. For example, the spoken phrase “felt worse this morning” (702)may have been muffled or poorly recorded and the speech to textconverter model may have only a 54 percent confidence that this is whatthe patient spoke. The user can click on the phrase “felt worse thismorning” at which point the transcript is displayed at that location andthe audio phrase is replayed. The user can accept or reject (i.e., edit)the note. The confidence indicator could also be displayed forsuggestions, such as the suggestions shown in FIG. 5 for the spoken word“Lipodrene.” Suggested words or phrases that have high confidence levels(e.g. >80%) will ordinarily not be accompanied by confidence indicators,and words or phrases that have a low confidence level, e.g., <30%, wouldordinarily not be suggested to the user. Thus, the confidence levels areonly provided for suggested words and phrases with intermediate levelsof confidence, say between 30 and 80 percent or between 30 and 70percent.

FIG. 8 shows an illustration of the workstation 210 when the user hasselected the Note tab 306. The transcript is displayed along with thenote in region 314, in this example in prose style. The page includes asearch tool 802 in which the user is searching for the term “pyrexia” ineither the transcript or the note. The search function is a “smart”search function, meaning that equivalents to “pyrexia” (i.e., fever,feverish, hot, sweaty etc.) in the transcript are also found. In thiscase, the transcript has five hits (see region 806) and the transcriptis showing the second hit, namely the patient mentioning of fever at804. Additionally the term “fever” in the note region 314 ishighlighted.

FIG. 9 is an illustration of how selecting a note segment maps ortranslates to the corresponding portion of the transcript and the audiorecording. In this example, the user has clicked on the phrase “weightgain” 902 in the note region 314, and the corresponding portion of thetranscript that is linked to the note phrase “weight gain” is shownhighlighted on the same screen. In this example, the Doctor mentionedthat “gained your weight” as indicated at 904. Similarly, if the userwere to select “knee pain” under the MSK category under the Symptomsbullet, the relevant portion of the transcript where the patient spoke acomplaint about knee pain would be shown with the phrase “pain in myknee” in the transcript highlighted. The user has the option to play theaudio recording at the lines containing the highlighted words to verifyaccuracy of the speech to text conversion.

FIG. 10 is an illustration of the workstation 210 display where the userhas selected the patient instructions tab 302. In this display there isa region 1000 were all patient instructions are gathered in one locationfor easy viewing and transmitting to the patient. In this example, thepatient instructions include a prescription (1002), an article to read(1004) and an option to select a template “what to do next” (1006). Acheck box is next to the prescript and article fields 1002 and 1004which can be unchecked in case the users wishes to cancel theseparticular instructions. By checking the open check box next to thetemplate description 1006 this template would be added to theinstructions. There is a field 1008 for the user to add custominstructions. When this field 1008 is selected there is a pop-up windowwith a list of handouts or instructions which are available forselection to send to the patient. At the bottom of the page there is anicon 1010 to send all the instructions to the patient via email. If icon1012 is selected the instructions are sent by SMS message to a smartphone or tablet of the patient. Further details on any of the templates,articles or other custom instructions can be displayed on the right handside of the page of FIG. 10. A scroll bar is included to scroll downthrough all the detailed information on the instructions since they maynot all be presented on the display at one time.

FIG. 11 shows another version of a further display 1106 of instructionsfor the patient, as well as a field for showing contact information forthe patient, including email addresses 1102 and phone number(s) 1104.This page presents the option to change SMS or email preferences amongthe list of contact information shown at 1102 and 1104 by eitherselecting or unselecting them with the mouse.

FIG. 12 shows an additional feature of the machine learning models whichare used in extracting highlighted text in the transcript. The machinelearning models are trained from labeled training data such that aspatients discuss their issues or symptoms, a suggested problem list isgenerated and displayed on the workstation to support doctors indecision making. Clinical decision support models generating suggestedproblem lists or questions for physicians are known in the art thereforea description is omitted for sake of brevity. For example, thepatient-doctor conversation may result in the generation of suggestedclinical problems shown at 1200 in FIG. 12, including diagnostic billingcodes. Additionally, problems that need addressing but that have notbeen brought up by the patient in the conversation may also be flagged.This is shown in the list of potential under-documented problems asindicated at 1202 in FIG. 12. In this example, hypertension is flaggedbecause at the previous visit the patient was showing high bloodpressure readings. Pre-diabetes is also flagged because the lasthemoglobin ATc measurement of 6.3% indicated that the patient has thepotential for becoming diabetic. The display of these suggested clinicalproblems and under-documented problems can be generated on theworkstation in the clinic or physician office during the patient visit,in substantial real time, therefore the healthcare provider can addressthese issues with the patient during the office visit then and there.

FIG. 13 illustrates a page displayed on the workstation of FIG. 2 whenthe user has toggled to a Billing tab. The page includes a display ofbilling codes 1300 and corresponding text 1302 from the note supportingthe billing codes. The region 1304 displays a list of pertinentquestions which are not yet asked, such as “when did the fever start”along with a reference to the line of the transcript (line 209) wherethe patient mentioned that they felt feverish. The page also displayspossible issues to explore with the patient, such as hypertension andpre-diabetes. The bottom of the page shows a region 1312 indicating theaudio recording is available for play, along with tools 1310 to pause,play, fast forward, rewind, etc. the recording. The transcript of theconversation is displayed when the up-arrow icon (A) 1314 is activated.In this example, the note in region 314 is displayed in a prose style.

FIG. 14 illustrates a feature by which smart scaling is included in thedisplay on the workstation to allow access to the audio recording andthe transcript and at the same time navigating to other patient data. Inthis example, the workstation shows the electronic health record of apatient, including a multitude of tabs for showing various componentparts of the record (medications, family history, vital signs, priorprocedures, prior notes, etc.). There is also shown a small icon 1402 atthe periphery of the display for playing or pausing the recording. Forexample, if the user was listing to the recording and viewing thetranscript but wanted to explore other aspects of the patients records,they could minimize the display (e.g., the display of FIG. 3, or FIG.13) and navigate to the patient's entire electronic health record andexplore what data there may be in there of interest to the currentdiscussion in the patient-provider conversation. Meanwhile, while theuser is navigating through the electronic health record, the small icon1402 remains on the page. By selecting it they can resume the renderingof the audio recording and the simultaneous generation of the transcriptand the note as explained above. This interface, e.g., of FIG. 3-12 canbe minimized during the visit and still actively record the patientvisit, to allow the doctor access to other desktop tools.

Once the healthcare provider has completed the process of reviewing andediting the transcript and note it can be downloaded and stored locally,e.g., in the electronic health record for the patient in the data store212 shown in FIG. 2 or on the hard drive of the workstation 210.

In view of the above, it will be appreciated that we also described asystem for facilitating automatic generating a note summarizing aconversation between a patient and a healthcare provider. The systemincludes a workstation 210 having a tool (icon, link or other) forrendering an audio recording of the conversation and generating atranscript of the audio recording using a speech-to-text engine, e.g.,as shown in FIG. 3. The workstation includes a display (FIG. 3) having afirst transcript region (312, FIG. 3) for display of the transcript ofthe recording and simultaneously a second note region (314, FIG. 3, FIG.4, FIG. 13, etc) for display of a note summarizing the conversation. Atrained machine learning model (FIG. 1, 104) extracts words or phrasesin the transcript related to medical topics relating to the patient, andin the system the extracted words or phrases are displayed in the noteregion 314 of the display (FIG. 4, FIG. 17, etc.). The extracted wordsor phrases in the note region 314 are linked or mapped to the portionsof the transcript from which the extracted words or phrases originatedwhereby the source and accuracy of the extracted words or phrases can beverified by a user of the workstation, e.g., as explained above inconjunction with FIG. 3, 4 etc.

Further by way of summary, the system and method of this disclosurefeatures a number of possible and optional variations or enhancements,such as: the extracted words or phrases are placed into appropriatecategories or classifications in the note region such as symptoms,medications, etc., as shown in FIG. 6, 7, 9, 17, 18, etc. Additionally,the speakers are identified in the transcript, e.g., FIGS. 3, 8 and 19.The transcript and note are editable, e.g., as shown in FIG. 5. Themethod may further include the step of automatically generatingsuggestions of alternative words or phrases for words or phrases in thetranscript and tools to approve, reject or provide feedback on thegenerated suggestions to thereby edit the transcript, e.g., as describedin FIG. 5 above. The method and system may rendering the note in a prosestyle, e.g., as shown in FIG. 8, or in the form of a bullet list, e.g.,FIGS. 6, 17, 18. Words or phrases in the transcript relating to symptomsor attributes of such symptoms are grouped and classified togetherwithin the note, e.g., as shown in FIGS. 7, 9, 17, 18. The note iseditable to change classifications and groupings of symptoms and symptomattributes, e.g., as shown in FIG. 4. The method and system may alsoprovide for displaying a confidence level for generated suggestions ofalternative words or phrases, e.g., as shown in FIG. 5. As shown inFIGS. 12 and 13, there may be a display of at least one of suggestionsof topics to follow-up with the patient, suggestions of clinicalproblems, suggestions of potential under-documented problems, andsuggested billing codes with portions of the transcript displayed whichjustify the billing codes. Additionally, there may be a step ofdisplaying an emailable or SMS-ready list of patient instructions (FIGS.10 and 11), including features for editing the list of instructions,adding new instructions from a list of available or suggestedinstructions, medication changes, or additions from a list generatedfrom the assessment and plan portion of the doctor's notes. As shown inFIG. 14, the method may further include displaying a minimized icon(1402) on a display of an electronic health record screen which, whenactivated, toggles to the audio recording of the conversation and thetranscript thereof.

Additional possible features include displaying on the workstationdisplay a search tool to search for words or phrases to insert into thenote, e.g., as shown in FIGS. 5 and 8. FIG. 8 shows a smart search toolpermitting searching across the transcript and note for words or phrasesidentical to and equivalent to a word or phrase entered into the smartsearch tool. The search tool of FIG. 5 integrates smart phrase or dotphrase search shortcuts present in the electronic health record of thepatient.

B. Automated Generation of Transcripts of Patient-Healthcare ProviderConversations and Visual Indicators to Build Confidence and Trust in theTranscript

This disclosure also relates to a method for generating a transcript ofan audio recording of a patient-healthcare provider conversation. Thedisclosure is related to methods to increase the trust in the transcriptand the credibility and confidence in the behind the scenes processingto create the transcript. As noted previously, physicians spend 20-30percent of their time on average documenting patient visit notes forproper billing. Capturing audio during a patient's examination andgenerating an automatic transcript, rather than relying on manual orcomputer note-taking, allows doctors to focus on their patients andexpedites a doctor's ability to write notes. Technology that extractsrelevant medical concepts from the transcript can streamlinedocumentation writing even more. However, the medical decision makingprocess is incredibly complex. Before integrating the outputs of machineintelligence into their practice's workflows, doctors must feel likethey understand how and why these automatic recommendations are made.

At the same time, doctors are already overloaded with information. Thepresent disclosure provides transparency into the machine transcriptionand information extraction process to build trust and credibility, whilealso at the same time minimizes the impact on the user's attention. Toaccomplish this, we developed novel user interfaces and interactionsthat provide supportive emphasis and rapid understanding of machineintelligence outputs.

As will be explained below, transcripts are annotated (i.e.,highlighted) with contextual information to promote trustworthiness andcredibility. Audio during patient/clinician interactions is captured andtranscribed in substantial real-time, with words appearing on a userinterface of a workstation shortly after being spoken. The doctor canconfirm at any time that audio is being recorded accurately.

Also in real-time, phrases for use in the medical note areauto-extracted from the transcript. Selecting a suggested note extracttoggles to the corresponding part of the transcript. These notehighlights are appended with suggested groupings per symptom andclassifiers per billing codes (tempo, onset, etc.) all of which can beapproved or rejected by the doctor.

The method uses a workstation (210, FIG. 2, 3) which provides for arendering of an audio recording of the conversation (e.g., through aspeaker on the workstation) and generating a display of a transcript ofthe audio recording (FIG. 3) using a speech-to-text engine insubstantial real time with the rendering of the audio recording. Thegenerating of the transcript in substantial real time with the renderingof the audio recording enables inspection of the accuracy of conversionof speech to text. The workstation includes a tool such as a scroll barfor scrolling through full length of the transcript and rendering theportion of the audio according to the position of the scrolling. Thus,the user can navigate through the transcript and re-play the portion ofthe audio at particular points in the transcript to confirm the accuracyof the conversion of speech to text.

Additionally, the method involves highlighting in the transcript wordsor phrases spoken by the patient relating to symptoms, medications orother medically relevant concepts relating to the medical condition ofthe patient. For example if the patient says “I felt feverish thismorning” the phrase “felt feverish” or just “feverish” and the phrase“this morning” would be highlighted in the transcript, as they arerelating to symptoms and onset of symptoms experienced by the patient.This feature calls out to the user's attention particularly important orsignificant words or phrases in the transcript.

Additionally, the method provides a set of transcript supplement toolswhich enable editing of specific portions of the transcript based on thecontent of the corresponding portion of audio recording. In particular,there may be portions of the audio recording where the patient's voicemay be muffled, they may mispronounce a significant word, such as thename of a medication, they only remember the first syllable or the pillcolor of the medication they are taking, etc. The transcriptionsupplement tools enable editing of these portions of the transcript,such as by displaying suggested alternative phrases, displayingcorrected medical terminology, displaying suggestions for incompletewords, etc., and tools for accepting, rejecting or editing thetranscript and the generated suggestions. Additionally, thesesuggestions may be accompanied by a display of an indication ofconfidence level in auto-suggested words or phrases.

The method of generating the transcript may be accompanied by otheroptional features, such as displaying a note simultaneously with thedisplay of the transcript and populating the note with the highlightedwords or phrases, e.g., as shown in FIG. 9. Additionally, the transcriptmay be minimized and the workstation may provide for viewing the noteonly, which is generated in substantial real time with the rendering ofthe audio recording. Additionally, the highlighted words or phrase areplaced into appropriate categories/classifications in the note such assymptoms, medications, etc. Supplementary information may be providedfor symptoms including labels for phrases required for billing. There isalso a linking of elements in the note to relevant parts of thetranscript, for example if the user clicks on a the phrase “feltfeverish” under a symptom heading in the note the relevant portion ofthe transcript where the patient describe this symptom is displayedadjacent to that portion of the note.

The following sections will describe further aspects of the method ofgenerating the transcript or use thereof which builds trust in thetranscript and credibility of the processing behind the scenes.

A. Real-Time Transcript that Scrolls/Updates

As shown in FIG. 3, as the patient and clinician are talking (or lateron when the audio recording is rendered on the workstation) there is anautomated generation of a transcript in real time that scrolls andupdates additional speech is recorded. FIG. 15 shows another example ofthis. There is a display 1502 on the workstation including audiocontrols 1504 (such as play, pause, fast forward etc.) that control therendering of the audio recording and as it plays the sound of thepatient speaking “well, my leg hurts” there is display of a transcriptof the speech (“well, my leg hurts). This display as shown in FIGS. 3and 15 provides a visual indication that the speech phrases are beingcaptured and transcribed accurately.

B. Highlights in the Transcript

Medically relevant words or phrases in the transcript are called out orhighlighted. For example, in FIG. 16 the patient has spoken the phrase“Well, my leg hurts” and the phrase “leg hurts” is shown in bold. Twolines later the patient states that they started to feel feverish andthe words “feeling” and “feverish” are also highlighted. The manner ofhighlighting is not particularly important and could take many forms,such as use of red font, larger font, bold face, underlining, etc.Again, as the audio recording is rendered and the transcriptiongenerated these medically relevant words or phrases are highlightedimmediately as the transcript is produced.

C. Minimize Transcript and Toggle to the Note-Only View

As the recording is rendered and the transcript generated as shown inFIGS. 3, 15 and 16, the physician may want to focus on the notegeneration process instead of the transcript per se and so the displayincludes a minimization tool for minimizing the region of the displaywhere the transcript is produced and thereby toggle to a note-only view.For example, in FIG. 17 there is shown a display of the words or phrasesforming a note in the note region 314 under appropriate headings orcategories, in this case a symptom category. FIG. 17 is like theillustration in FIG. 6, however, in FIG. 17 the patient has just spokenthe phrase “I developed a rash on my right shin” and immediately thewords “rash” (1702) and “right shin” (1704) are then placed in the noteunder the symptom heading.

D. Note Suggesting Grouping/Classifiers

As the word or phrase excerpts from the transcript are placed into thenote they are grouped into recommended sections, aligned with how notesare currently structured in practice. Supplementary information forsymptoms include labels of key phrases required for billing, assuggested by the machine learning models of FIG. 1. For example, in FIG.18, there is shown a note region 314 in which the phrase “leg hurts” isplaced in a section entitled “chief complaint”. Under the history ofpresent illness section (HPI) there is a list of additional symptomsextracted from the transcript including onset, alleviating and tempo.

E. Ability to Accept/Reject Transcript and Note Suggestions

The user interface shown in the Figures includes the ability to edit thetranscript and the note, including the ability accept or rejectsuggestions for the transcript and note, e.g., when the words aremisspoken, the speech is muffled or partially inaudible, or othersituations arise when the speech recognition engine is not confident asto the words spoken. In the example of FIG. 19 the patient was askedabout the medication and state the name “Lipodrene”, a term not in thevocabulary of the NER model, and the user is presented with twoalternatives 1904 and 1906 which may the name of the medication thepatient intended to say. The user can select either one or reject themby activating the X icon 1908. Furthermore, the user can changeclassifications for the suggestions, through moving items to differentgroupings, changing drop downs, deleting suggestions or adding morecontext. An example of this was shown in FIG. 4 with the moving of themoving of the extracted phrase “leg hurts” from the symptoms region inthe note to the chief complaint region of the note.

F. Transcript Suggestion for Uncertain Phrases

If the automated speech recognition function in the speech to textconverter model (FIG. 1) is unable to pick up a phrase, or perhapspatients are unsure of the right word (especially in regards tomedication names) the interface provides for automatically suggestingappriate alternative words or phrases. In FIG. 20, there is shown aportion of a transcript 2000 in which the physician (“MA”) asked thepatient if they were still using their inhaler for their asthma (2002)with “inhaler for your asthma” highlighted. The patient then mentions“Sometimes”, which is highlighted, and then a few sentences later says“The Ben-thing is newer.” The word “Ben-thing” is not recognized and sothe NER model proposes the display of the medication Benazepril, 10 mg,asthma inhaler in the note region 314. The user can accept, edit orreject the suggestion of including Benazepril 10 mg in the note.

G. Transcript Confidence Indicator for Muffled Phrases

As was described previously in conjunction with FIG. 7, for phrases thatare auto-suggested the display includes an expectation of the certaintyabout the suggestion. This display of confidence levels may also applyto display of terms in the note and not just terms in the transcript.

H. Link Note to Relevant Parts of the Transcript

As explained previously, there is a linking or mapping between the notefragments (words or phrases) and the portions of the transcript fromwhich such fragments originated. Thus, the note fragments can be clickedor tapped to view how they were generated based on what was statedthrough the transcript. See the previous discussion of FIG. 9.

I. Terminology is Adapted to Professionally Preferred Terms

In applicable cases the terminology in the note is adapted toprofessionally preferred terms. For example, in FIG. 21 the note hasreplaced “rash” with “dermatitis” and “feeling feverish” with “pyrexia.”

In view of the above, we have described a workstation (210) displaying atranscript of a conversation between a patient and a healthcareprovider. The workstation includes a tool, e.g., icon, tab, link, etc.for a rendering of an audio recording of the conversation and generatinga display of the transcript of the audio recording using aspeech-to-text engine in substantial real time with the rendering of theaudio recording, thereby enabling inspection of the accuracy ofconversion of speech to text. See e.g., FIGS. 3, 15, 16. The workstationfurther includes a tool such as scroll bar (311, FIG. 3) for scrollingthrough the full length of the transcript and rendering the portion ofthe audio according to the position of the scrolling. The display of thetranscript including a highlighting of words or phrases spoken by thepatient relating to symptoms, medications or other medically relevantconcepts, see FIGS. 3, 8, 9 etc. The workstation further includes a setof transcript supplement tools enabling editing of specific portions ofthe transcript based on the content of the corresponding portion ofaudio recording.

We claim:
 1. A method for automatically generating a note summarizing a conversation between a patient and a healthcare provider, comprising: providing on a workstation a tool for rendering an audio recording of the conversation; displaying on a display of the workstation (1) in first transcript region a transcript of the recording in substantial real time with the rendering of the audio recording and simultaneously (2) in a second note region the note summarizing the conversation, the note including automatically extracted words or phrases in the transcript related to one or more medical topics relating to the patient, the extraction of the words or phrases performed by a trained machine learning model; generating, by the trained machine learning model: (1) a billing code associated with a given medical topic of the one or more medical topics, wherein the billing code is based on the automatically extracted words or phrases, and (2) a textual description to support the billing code, wherein the textual description is based on the transcript and the billing code; displaying on the display of the workstation, the billing code and the textual description; and providing links or a mapping between the extracted words or phrases in the note region and portions of the transcript from which the extracted words or phrases originated whereby the source and accuracy of the extracted words or phrases in the note region can be verified by a user of the workstation.
 2. The method of claim 1, wherein the extracted words or phrases are placed into appropriate categories or classifications in the note region, wherein the categories or classifications relate to one or more of a symptom, a medication, or a diagnosis.
 3. The method of claim 1, further comprising: identifying, in the transcript, whether a speaker during the conversation is the patient or the healthcare provider.
 4. The method of claim 1, wherein the transcript and the note are editable.
 5. The method of claim 1, wherein the method further comprises the step of automatically generating suggestions of alternative words or phrases for words or phrases in the transcript and tools to approve, reject or provide feedback on the generated suggestions to thereby edit the transcript.
 6. The method of claim 1, wherein words or phrases in the transcript relating to symptoms or attributes of the symptoms are grouped and classified together within the note.
 7. The method of claim 6, wherein the note is editable to change classifications and groupings of symptoms and symptom attributes.
 8. The method of claim 5, further comprising the step of displaying a confidence level for generated suggestions of alternative words or phrases.
 9. The method of claim 1, further comprising the step of displaying at least one of suggestions of topics to follow-up with the patient, and suggestions of clinical problems.
 10. The method of claim 1, further comprising the step of displaying an emailable or SMS-ready list of patient instructions, including features for editing the list of instructions, adding new instructions from a list of available or suggested instructions, medication changes, or additions from a list generated from the assessment and plan portion of the doctor's notes.
 11. The method of claim 1, further comprising displaying a minimized icon on a display of an electronic health record screen which, when activated, toggles to the audio recording of the conversation and the transcript thereof.
 12. The method of claim 1, further comprising displaying on the workstation interface a smart search tool permitting searching across the transcript and note for words or phrases identical to and equivalent to a word or phrase entered into the smart search tool.
 13. The method of claim 11, wherein the search tool integrates smart phrase or dot phrase search shortcuts present in the electronic health record of the patient.
 14. The method of claim 1, further comprising: displaying on the display of the workstation a list of one or more questions to follow-up with the patient in substantial real time during the conversation, wherein the one or more questions are related to the extracted words or phrases in the transcript, and wherein the one or more questions have not yet been asked during the conversation.
 15. The method of claim 1, further comprising: identifying, based on an electronic health record of the patient comprising a previously performed medical diagnostics test result, at least one under-documented medical problem relating to the patient, wherein the at least one under-documented medical problem has not been discussed during the conversation; and displaying on the display of the workstation the at least one under-documented medical problem relating to the patient.
 16. The method of claim 1, wherein the trained machine learning model to perform the generating of the billing code and the textual description is a clinical decision support model.
 17. The method of claim 1, wherein the displaying of the billing code and the textual description further comprises: receiving, via the display of the workstation, an indication to toggle to a billing tab displayed by the display of the workstation; and displaying, in response to the indication to toggle to the billing tab, the billing code and the textual description in a display associated with the billing tab.
 18. The method of claim 1, further comprising: identifying an inaudible word or phrase in the audio recording of the conversation; automatically generating a suggestion of one or more alternative words or phrases to replace the inaudible word or phrase; and displaying on the display of the workstation the one or more alternative words or phrases to replace the inaudible word or phrase.
 19. The method of claim 1, further comprising: determining, from the audio recording of the conversation, an incorrect or incomplete mention of a medication by the patient; automatically generating a suggestion of one or more alternative medications to replace the incorrect or incomplete mention of the medication; and displaying on the display of the workstation the one or more alternative medications.
 20. A system for facilitating automatically generating a note summarizing a conversation between a patient and a healthcare provider, comprising: a workstation having a tool for rendering an audio recording of the conversation and generating a transcript of the audio recording using a speech-to-text engine; the workstation having a tool for displaying a first transcript region for display of the transcript of the recording and simultaneously displaying a second note region for display of the note summarizing the conversation, wherein the note region displays extracted words or phrases in the transcript related to one or more medical topics relating to the patient, and wherein the extracted words or phrases in the note region are linked or mapped to the portions of the transcript from which the extracted words or phrases originated whereby the source and accuracy of the extracted words or phrases can be verified by a user of the workstation; and the workstation having a tool for displaying a billing code and supporting textual description that have been generated by a trained machine learning model, wherein the billing code is associated with a given medical topic of the one or more medical topics, wherein the billing code is based on the extracted words or phrases, and wherein the textual description is based on the transcript and the billing code.
 21. The system of claim 20, wherein the extracted words or phrases are placed into appropriate categories or classifications in the note region, wherein the categories or classifications relate to one or more of a symptom, a medication, or a diagnosis.
 22. The system of claim 20, wherein the transcript further includes an identification of whether a speaker during the conversation is the patient or the healthcare provider.
 23. The system of claim 20, further comprising a trained machine learning model configured to generate suggestions of alternative words or phrases for words or phrases in the transcript and wherein the workstation further includes tools to approve, reject or provide feedback on the generated suggestions to thereby edit the transcript.
 24. The system of claim 23, wherein the trained machine learning model generates a confidence level for generated suggestions of alternative words or phrases.
 25. The system of claim 20, wherein the workstation further is configured to display a minimized icon on a display of an electronic health record screen which, when activated, toggles to the audio recording of the conversation and the transcript thereof.
 26. The system, of claim 20, workstation is configured to generate a display of a search tool to search for words or phrases to insert into the note.
 27. The system of claim 20, further comprising a smart search tool permitting searching across the transcript and the note for words or phrases identical to, or equivalent to, a word or phrase entered into the smart search tool.
 28. The system of claim 25, wherein the search tool integrates smart phrase or dot phrase search shortcuts present in the electronic health record of the patient.
 29. The system of claim 20, further comprising a microphone for recording the conversation.
 30. A workstation displaying a transcript of a conversation between a patient and a healthcare provider, comprising: a tool for rendering an audio recording of the conversation; a tool for generating a transcript of the audio recording using a speech-to-text engine; a tool for (1) displaying the transcript of the recording in substantial real time with the rendering of the audio recording, and (2) displaying a note summarizing the conversation, the note including automatically extracted words or phrases in the transcript related to one or more medical topics relating to the patient, the extraction of the words or phrases performed by a trained machine learning model; a tool for displaying a billing code and supporting textual description that have been generated by a trained machine learning model, wherein the billing code is associated with a given medical topic of the one or more medical topics, wherein the billing code is based on the extracted words or phrases, and wherein the textual description is based on the transcript and the billing code; and a tool for providing links or a mapping between the extracted words or phrases in the note region and portions of the transcript from which the extracted words or phrases originated whereby the source and accuracy of the extracted words or phrases in the note region can be verified by a user of the workstation. 